Walking with Awareness
Registration for walking class

We are currently on a pilgrimage to India. We are not offering these walking classes until farther notice.

Fill out the following Registration form to register for our Walking with Awareness walking classes. If you are registering for more than one person, please fill one form per person and indicate in the comment field who you are together with.

Fields marked with an asterisk (*) are required.

Today's date:

* Class:
Wednesday morning 8:30 to 10.
Wednesday afternoon 5:30 to 7.
Individual class set up privately with Petra.

* First name: Middle Initial:
* Last name:
Birthday (optional):

Address line 1:
Address line 2:
City: State:
ZIP:

* Email address:
Home phone with prefix:
Cell phone with prefix:

Emergency contact:
Name:
Phone number with prefix:
Cell number with prefix:

Can you tell us where you learned about our Walking With Awareness walking classes?

Please add any comments you have below:

After you click Send, your data will be forwarded to us and you will be returned to this page.

Return to Walking with Awareness walking class page.
Go to Payment page.

Copyright © 2012-2013 Mike Metras, www.PilgrimageCreations.com